Esophageal Infections
Odynophagia, and to a lesser degree, dysphagia are most common symptoms
Others: Nausea, dysgeusia, heartburn, chest pain, fever, bleeding, hiccups
FUNGAL: CANDIDA ALBICANS
Most common cause of infectious esophagitis; Ubiquitous yeast found in normal oral flora
First step: colonization with mucosal adherence and proliferation; 20% of asymptomatic persons
Second step: impaired host defense; Creamy white plaques or exudates seen endoscopically
75% of patients with candidal esophagitis have coincident oral infections; However, the absence of thrush does not exclude the diagnosis
Predisposing medications: corticosteroids, antibiotics affecting normal flora, acid suppression
Predisposing conditions: impaired immunity: HIV, hematologic malignancies, DM, Cushings, ETOH, disease of peristalsis (achalasia)
In immunocompromised population, trial of fluconazole 100-200 mg/day for 10-14 days; If no resolution in 5-7 days: EGD
Nystatin is effective at a swish-and-swallow 500,000 units 5/day; However oral imidazoles are preferred
Prophylaxis with fluconazole 150 mg/week can be recommended
If patient is granulocytopenic, should receive amphotericin B because of high risk of fungal disseminationRelated posts:
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